Complete an appropriate sexual health history, appropriate to the concern

Bring closure to a current appointment and segue to a subsequent appointment if needed

When appropriate, recommend and refer to a qualified specialist best suited to address the patient’s sexual concern

Psychosocial Issues

Sexual function does not exist in a vacuum—it is influenced by relationships, fatigue, stress, and other sociocultural factors in a woman’s life. The following issues are important to assess to provide the appropriate context for your clinical evaluation:

Sexuality and desire can be deeply affected by the health, stability, and status of the woman’s relationship

There is an important difference between sexual drive (primarily the biological component of desire) and sexual motivation (primarily the intrapsychic and interpersonal components)

Current and past abuse can impact sexual health; ask about a history of sexual abuse in routine health care examinations with clear, direct questions (e.g., “Has anyone, including your partner or a family member, ever forced you to do something sexually that you did not want to do?”)

Cultural and religious backgrounds can influence sexual health; therefore, without judgement, ask about the patient’s values, beliefs, and desires regarding sexuality and sexual activity within her relationship(s)

A partner’s sexual dysfunction can affect your patient’s sexual health and satisfaction; be sure to ask about the health and well-being of the patient’s partner(s) as well

Sexual Drive

vs

Sexual Motivation

Based on neuroendocrine mechanisms and evidenced by spontaneous sexual interest

Relative, and each person has a certain drive level

Exact neuroendocrine mechanisms responsible for drive remain unclear

In some, sexual drive declines progressively as a function of aging

Characterized by the willingness of a person to engage in sexual activity

Often the most important component of sexual desire

Can be impacted by the quality of a relationship, psychologic functioning, worries about health, children

A person can have high levels of sexual desire but if they have conflict with their partner or are suffering from clinical depression, motivation to be sexual will often be lacking

Open-Ended “Icebreakers” To Start The Discussion

The following phrases can open a dialogue about sexual health with your patients. When you talk about this issue within the overall history will vary. Many health professionals use them in the social history or review of systems. They are also helpful in assessing the personal, relationship, and global impact of sexual concerns.

It is part of my routine to ask about sexual health as part of the well-woman visit. Tell me about any sexual concern/problem/issue you may be having.

How do you think this sexual problem may be affecting your relationship or your life in general?

Please describe your sexual problem.

What distresses you the most about this sexual problem?

What have you tried to manage the problem so far?

Do you have any medical conditions that affect your quality of life, including your sexual health?

What would a successful resolution of your sexual problem(s) look like?

Tell me about the conversations you have had with your partner so far about this problem.

You may also want to consider asking close-ended questions which require a direct answer (i.e., Does sex hurt? Are you sexually satisfied?). Follow-up these close-ended questions with another open-ended comment to allow further expansion of the problem (i.e., Tell me more. What do you mean by that?). Encourage the woman to use her own language with which she is most comfortable. If you are unfamiliar with her terms, do not be afraid to ask for clarification.

Female Sexuality Patient Handouts

There are a number of sources for obtaining patient handouts on female sexuality. They are best utilized as adjuncts to patient/clinician discussion, not as an alternative to them.

American Association of Sexuality Educators Counselors and Therapists (www.aasect.org)

Looking for medically accurate, up-to-date, evidence-based educational programming for health care providers and materials for patients on all reproductive health topics, including abortion, contraception, HPV, menopause, menstruation, pregnancy, sexuality? Look no further than the Association of Reproductive Health Professionals (ARHP) – the leading source for trusted medical education and information on reproductive and sexual health.